When do health insurance benefits reset?
Extras benefits reset each year, and they don't roll over! Make sure you maximise your claims before your fund's cut off date.
Key takeaways
- Extras health insurance gives you a yearly benefit for treatments like optical and dental.
- These benefits reset each year, generally on January 1st, July 1st, or the anniversary of your policy start date.
- Extras benefits do not typically roll over, so you should try and use them before they reset.
When do health funds reset extras benefits?
Extras benefits reset on 3 different dates: January 1st, July 1st, or the anniversary of your policy start date. This table lists the dates that each fund uses, as of April 2024.
| Fund | When Extras Reset |
|---|---|
| ahm health insurance | 1 July |
| HCF | 1 January |
| Medibank Private | 1 January |
| NIB | 1 January |
| Qantas Health Insurance | 1 January |
| Suncorp | 1 January |
| ACA | 1 January |
| APIA | 1 January |
| Australian Unity | 1 January |
| Bupa | 1 January |
| CBHS Health Fund | 1 January |
| Hunter Health | Policy start anniversary |
| Defence Health | 1 July |
| Doctors' Health Fund | 1 January |
| Emergency Services Health | 1 January |
| Frank | 1 January |
| GMHBA | 1 January |
| Grand United Corporate Health | Policy start anniversary |
| HBF | 1 January |
| Health Care Insurance | 1 January |
| HIF | 1 January |
| Health Partners | 1 January |
| Latrobe Health Services | 1 January |
| Mildura Health Fund | 1 January |
| MyOwn Health | 1 January |
| onemedifund | 1 July |
| Navy Health | 1 July |
| Nurses & Midwives Health | 1 January |
| Peoplecare Health Insurance | 1 July |
| Phoenix Health Fund | 1 January |
| Police Health | 1 January |
| Queensland Country Health Fund | Policy start anniversary |
| RT Health Fund | 1 January |
| RBHS | 1 January |
| St.Lukes Health | 1 January |
| Teachers Health | 1 January |
| TUH | 1 January |
| UniHealth | 1 January |
| Westfund | 1 January |
Finder survey: Do Australians understand how their health insurance extras limits work?
| Response | |
|---|---|
| Yes | 55.79% |
| Somewhat | 38.22% |
| No | 5.98% |
Source: Finder survey by Pure Profile of 1006 Australians, December 2023
What other limits can apply?
There are a few other extras cover limits you should be aware of.
- Waiting periods: All extras policies have a waiting period before you will be able to claim (with a few exceptions). This period is typically 2, 6 or 12 months, but can be as long as a few years for things like hearing aids or braces.
- Claim time limit: You need to make a claim within a certain time after you get a service. This time limit is typically 2 years.
- Service limit: There may be a limit on the number of times you can claim a benefit for the same service in a year. For example, you may be allowed to only claim 2 dentist appointments per year.
- Daily claim limit: Some health funds limit you to claiming one extras benefit per day. So if you receive multiple services within one consultation, you may only be able to claim the service which attracts the higher benefit.
What are the types of services that have annual limits?
Annual limits usually apply to a wide range of general treatments included in extras cover, such as:
- General dental
- Major dental
- Orthodontics
- Physiotherapy
- Chiropractic services
However, there are certain parts of extras cover to which annual limits don't usually apply, for example ambulance cover.
"I've found that my go-to health providers are always busiest in the two months leading up to the time that extras benefits reset (Nov-Dec and May-Jun). So I don't miss out on making my claims before my extras reset, I make sure to plan ahead and book my appointments outside of these busy periods, particularly for my optom and dental visits. I find it easy to avoid these busy periods by pre-booking my next appointment in advance when I go for my check-up. I can then reschedule my appointment if needed once I've been sent a reminder to confirm attendance. "
What is the difference between a combined limit and a sublimit?
When comparing extras cover, it's important to be aware that sub-limits and combined annual limits may also apply. While your policy may have an annual limit of $1,000 for general dental services, there may also be a sub-limit that sets the maximum amount you can claim for a specific dental treatment, for example a routine checkup or a basic extraction. This sub-limit is subtracted from the larger annual limit.
However, combined annual limits may also apply. For example, your policy may provide up to $300 cover for each of the following services: physiotherapy, chiropractic treatment and osteopathy. However, those services may also be grouped together into one category with a combined annual benefit limit of $750 – so the maximum yearly amount you can claim for all the physio, chiro and osteo services you receive is $750.
Sources
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